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Case Reports
. 2023 Sep;51(9):3000605231199019.
doi: 10.1177/03000605231199019.

Repeated pulmonary nodules as the primary symptom of familial hemophagocytic lymphohistiocytosis in adults: a case report and review

Lulu Zhang  1 , Chuanchuan Dong  1 , Qiannan Wu  1 , Yupeng Li  1 , Liting Feng  1 , Yanqing Xing  1 , Yangdou Dong  2 , Le Liu  1 , Xiaohui Li  1 , Rujie Huo  1 , Yanting Dong  1 , Erjing Cheng  1 , Xiaoyan Ge  1 , Tian Xinrui  1
Affiliations
Case Reports

Repeated pulmonary nodules as the primary symptom of familial hemophagocytic lymphohistiocytosis in adults: a case report and review

Lulu Zhang et al. J Int Med Res. 2023 Sep.

Abstract

Pulmonary nodules are usually considered to be associated with malignant tumors and benign lesions, such as granuloma, pulmonary lymph nodes, fibrosis, and inflammatory lesions. Clinical cases of pulmonary nodules associated with hemophagocytic lymphohistiocytosis have rarely been reported. Therefore, when patients develop pulmonary nodules, the possibility of developing hemophagocytic lymphohistiocytosis is often not considered. We report the first case of familial hemophagocytic lymphohistiocytosis with recurrent pulmonary nodules as the first symptom. Our findings will hopefully provide new ideas for the diagnosis and treatment of pulmonary nodules in the future.

Keywords: Aspergillus infection; Pulmonary nodule; case report; familial hemophagocytic lymphohistiocytosis; hematological disease; lesion.

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Conflict of interest statement

Declaration of conflicting interestThe authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Chest computed tomography shows the first appearance of symptoms in the patient. Multiple nodules and patchy exudates can be seen.
Figure 2.
Figure 2.
Chest computed tomography shows no absorption of the nodules after using empirical antibiotics.
Figure 5.
Figure 5.
Computed tomography shows that the patient has enlarged lesions after she decided to stop taking prednisone for the first time.
Figure 3.
Figure 3.
Chest computed tomography shows some absorption of the lesions after the first prednisone therapy.
Figure 4.
Figure 4.
Computed tomography shows a reduced lesion volume after prednisone therapy.
Figure 6.
Figure 6.
Computed tomography shows an increased volume of multiple nodules and plaque exudates after the second discontinuation of prednisone therapy.
Figure 7.
Figure 7.
Computed tomography does not show considerable absorption of the lesions after switching to antifungal therapy.
Figure 8.
Figure 8.
Computed tomography shows absorption of the lesions in the patient after using prednisone therapy combined with antifungal therapy.
Figure 9.
Figure 9.
Computed tomography shows an improvement in the lesions compared with a few months previously because of taking regular medication
Figure 10.
Figure 10.
Computed tomography shows absorption of the lesions after continuous treatment
Figure 11.
Figure 11.
Computed tomography shows that the range of imaging lesions has expanded and increased in density after symptoms of persistent fever, muscle soreness, and pancytopenia.
Figure 12.
Figure 12.
Results of a bone marrow examination.
Figure 13.
Figure 13.
Computed tomography shows that the lesions have absorbed in the patient after treatment with the HLH-2004 regimen.
See this image and copyright information in PMC

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